Chapter 7: Developing and Gaining Support for a PHM IT Investment Road Map - Step 7; Conclusion
Excerpted from original article published by Population Health Management, copyright Mary Ann Liebert, Inc.
Guide for Developing an Information Technology Investment Road Map for Population Health Management
Jacquelyn Hunt, PharmD, MS, Richard Gibson, MD, PhD, John Whittington, MD, Kitty Powell, Brad Wozney, MD, Susan Knudson, MA
Many health systems recovering from a massive investment in electronic health records are now faced with the prospect of maturing into accountable care organizations. This maturation includes the need to cooperate with new partners, involve substantially new data sources, require investment in additional information technology (IT) solutions, and become proficient in managing care from a new perspective. This seven-part series, with excerpts drawn from the article originally composed by leading authorities on population health management and enabling IT, will help organizations chart their position on the population health readiness spectrum and enhance their chances for a successful transition from volume-based to value-based care.
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Developing and Gaining Supportfor a PHM IT Investment Road Map
Step 7. Implement PHM IT solutions in the context of a learning system
Organizations that have successfully traversed the previous 6 steps can, and often do, under-consider and under-resource this final step. It could be argued that this last step should, in fact, top the list of steps. It requires heroic effort for health care delivery systems to begin the transformation to a health and wellness focused business. Beyond implementation of technology, successful transformation requires leadership, planning, infrastructure and workflow design, measurement, and self-study.26,46–48
Successful learning organizations implement technology, information, and process within a supportive learning environment to create a cause-and-effect loop (Fig. 2) that encourages relational understanding and improvement of the system as a whole and its various components.49 When redesigning processes, recognize that PHM stakeholders (ie, executive, mezzanine, frontline, and patient and family) will be on a continuum of embryonic to mature regarding their insights into their own needs, as well as their relationship to the needs of other user roles. Rapid production and deployment of actionable information within a well-executed project plan can promote learning and advancement within and between user roles.
Team learning, built on personal mastery and shared vision, is another principle of a learning organization. We are impressed by the large and growing body of evidence demonstrating that workflow redesign emphasizing ‘‘team-based care’’ improves safety, quality outcomes, patient experience, and provider satisfaction.50 Many organizations are investing in developing more team-based care models. Not surprising is the finding that team cohesion is associated with higher adoption and diffusion of health IT.51,52 Thus, organizations that have been successful in creating high-performing teams with clear role-based workflows can expect that their investment in PHM IT will yield greater return.
At a high level, the 7 steps identified represent a logical approach to identifying any type of high-priority IT investment. However, during times of significant challenge and industry stress, it serves an organization well to ensure broad understanding of the process and fastidious execution of the steps.
Organizations embracing the transformation from traditional fee-for-service to value-based PHM are finding significant gaps in their IT capabilities. Shifting business models and care delivery partners complicate the IT governance, evaluation, and selection process. In the future, new data sources, funding, and innovation will drive more robust and patient-centered health IT development to enable superior Triple Aim performance. However, today the PHM IT market is immature. Most organizations find that more than 1 solution must be developed or purchased to close their PHM business requirement gaps. Executing a thoughtfully designed PHM IT evaluation methodology will bolster an organization’s ability to make astute investment decisions. Ultimately, maximizing the value of any PHM IT investment is highly dependent on the extent to which teams work in a learning system to support continual innovation and improvement.
26. James BC, Savitz LA. How Intermountain trimmed health care costs through robust quality improvement efforts. Health Aff (Millwood). 2011;30:1185–1191.
46. Swenson S, Pugh M, McMullan C, Kabcenell A. Highimpact Leadership: Improve Care, Improve the Health of Populations and Reduce Costs. IHI White Paper. Cambridge, MA: Institute for Healthcare Improvement; 2013.
47. Bohmer RMJ. The four habits of high-value health care organizations. NEJM. 2011;365;2045–2047.
48. DeVore SD, Figlioli. Lessons Premier hospitals learned about implementing electronic health records. Health Aff (Millwood). 2010;29:664–667.
49. Senge PM. The Fifth Discipline—The Art & Practice of The Learning Organization. New York: Currency; 1990.
50. Goldberg DG, Beeson T, Kuzel AJ, Love LE, Carver MC. Team-based care: a critical element of primary care practice transformation. Popul Health Manag. 2013;16: 150–156.
51. Graetz I, Reed M, Shortell SM, Rundall TG, Bellow J, Hsu J. The association between EHRs and care coordination varies by team cohesion. Health Serv Res. 2014;49:438–452.
52. Edmondson AC, Bohmer RM, Pisano GP. Disrupted routines: team learning and new technology implementation in hospitals. Adm Sci Q. 2001;46:685–716.